Provider Demographics
NPI:1386753408
Name:DUBOIS, HENRY (PT)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:DUBOIS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 WOODBERRY DR
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-6718
Mailing Address - Country:US
Mailing Address - Phone:609-226-8037
Mailing Address - Fax:856-346-8807
Practice Address - Street 1:125 WOODBERRY DR
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-6718
Practice Address - Country:US
Practice Address - Phone:609-226-8037
Practice Address - Fax:856-346-8807
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA00973900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist